Provider Demographics
NPI:1437421336
Name:PACIFIC SPINE & JOINT MEDICAL GROUP
Entity Type:Organization
Organization Name:PACIFIC SPINE & JOINT MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOSHE
Authorized Official - Middle Name:MILLER
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-377-7368
Mailing Address - Street 1:1618 SULLIVAN AVE
Mailing Address - Street 2:SUITE #208
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-1967
Mailing Address - Country:US
Mailing Address - Phone:650-994-4444
Mailing Address - Fax:650-994-3051
Practice Address - Street 1:1618 SULLIVAN AVE
Practice Address - Street 2:SUITE #208
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-1967
Practice Address - Country:US
Practice Address - Phone:650-994-4444
Practice Address - Fax:650-994-3051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-07
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA902042081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty